Pediatric GERD Medicine

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All babies spit up from time to time — especially
after a feeding. However, babies who spit up frequently and have other symptoms,
such as poor weight gain, irritability, or a prolonged cough, may have
gastroesophageal reflux disease (GERD).

In GERD, the contents of the stomach, such as
acid and food, are regurgitated back up the esophagus. Sometimes this can cause
your infant to vomit. This can lead to poor weight gain and erosion of the
esophagus.

GERD occurs in infants for several reasons. However,
it’s usually because the lower esophageal sphincter, which closes the esophagus
off from the stomach, may not be mature enough to close properly.

Just like GERD in adults, GERD in infants can
be managed several ways. Your doctor may first recommend that you make changes
in feeding, such as:

adding rice milk or cereal to your
infant’s bottle

burping your infant after they
have consumed one to two ounces of breast milk or formula

avoiding overfeeding

holding your infant upright for
30 minutes after a feeding

If changes in feeding don’t seem to help your
baby, your doctor may recommend medications.

Types
of medications

There are several types of medications that may
help relieve GERD symptoms.

Antacids

Gastric acid-buffering agents, or antacids,
help neutralize acid from the stomach. Some examples include Rolaids and
Alka-Seltzer. Though they help relieve symptoms, antacids aren’t recommended
for long-term use because they can cause complications and side effects, such
as diarrhea and constipation.

Check the labels of all over-the-counter
medications before you give them to your child. Most over-the-counter antacids
aren’t approved for children under the age of two.

Mucosal surface barriers

Mucosal surface barriers or foaming agents
help protect the surface of the esophagus from stomach acid. One example is
Gaviscon, which is approved for infants over one year old. The main side
effects of this medication are constipation and diarrhea.

Gastric antisecretory agents

Gastric antisecretory agents help reduce the
amount of acid the stomach produces and are the GERD medications most commonly
prescribed for infants. There are two kinds of antisecretory agents that help
reduce the acid in the stomach. These are histamine H2 receptor antagonists
(H2RAs, or H2 blockers) and proton pump inhibitors (PPIs).

H2RAs

Some common H2RAs are:

cimetidine (Tagamet)

ranitidine (Zantac)

famotidine (Pepcid)

nizatidine (Axid)

These medications start working quickly. However,
they aren’t usually recommended for long-term use in infants.

PPIs

PPIs are another class of drugs that reduce
the amount of acid in the stomach. Some common PPIs are:

esomeprazole (Nexium)

omeprazole (Prilosec)

lansoprazole (Prevacid)

rabeprazole (AcipHex)

pantoprazole (Protonix)

PPIs are generally more effective than H2RAs
and are better for healing the esophagus from gastric secretions. Experts
recommend using the smallest possible daily dose for infants.

PPIs aren’t officially approved for general
use in infants under one year old. However, esomeprazole has recently been approved
for use in infants over one month old for certain conditions.

Your child’s doctor may consider prescribing these
medications if they believe the benefits outweigh the risks.

Additional
facts about GERD medications

Both H2RAs and PPIs reduce the amount of acid
in the stomach. Therefore, infants who take these medications are at increased
risk for pneumonia and gastrointestinal tract (GI) infections. This is because
stomach acid can help to protect from infection.

Prolonged use of PPIs can make it difficult
for the body to absorb calcium. PPIs have been connected with an increased risk
for bone fractures in adults. However, there hasn’t been research done to
examine a link between bone fractures and infants.

Work closely with your doctor to understand
the benefits and risks of any medication prescribed for your infant.